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Croup or LTB: respiratory illness of infant and young children

  • Croup or LTB (Laryngo tracheo bronchitis) is respiratory illness of infants and young children which starts just like any other viral illness but can be life threatening if danger signs are ignored.
  • Croup is a respiratory illness usually caused by a virus. As the illness progresses, windpipe becomes swollen, which narrows the space available for air to enter the lungs.
  • The viruses that cause croup can be spread easily through coughing, sneezing, and respiratory secretions (mucus, droplets from coughing or sneezing).
  • Croup is usually mild, although it is possible for symptoms to become severe and life-threatening. Symptoms usually start gradually, beginning with nasal irritation, congestion, and a runny nose, which may worsen after 12 to 48 hours to include difficulty breathing, a “barking cough”, and hoarseness. Symptoms of croup usually resolve within one week.
  • If, at any time, a child develops features of worsening or severe croup, the parent should seek immediate medical attention. Danger signs include:
  1. Difficulty breathing
  2. Pale or blue-tinged skin, especially in the lips, fingers, toes, or earlobes
  3. Severe coughing spells
  4. Drooling or difficulty swallowing
  5. Inability to speak or cry due to difficulty taking a breath
  6. A whistling sound with breathing or noisy-high pitched breathing while sitting or resting(stridor)
  7. Sucking in of skin around the ribs with breathing (retractions)
  • Mild croup can usually be treated at home. Home treatment includes using mist from a humidifier or by sitting with the child in a bathroom filled with steam generated by running hot water from the shower. Hot steam humidifiers should be avoided because of the risk of burns.
  • Severe croup is a life-threatening illness and treatment should not be delayed for any reason and opinion of child specialist doctor should be taken immediately (as oxygen and need to secure the airway is needed).
  • Clinical Diagnosis: No investigation is needed.
  • TREATMENT:
    • Child may be given mist treatment (humidified air) in addition to a single dose of a glucocorticoid medication. The most frequently used glucocorticoid is dexamethasone.
    • Coughing can be treated with warm, clear fluids to loosen mucus on the vocal chords. Warm water, apple juice, or lemonade is safe for children older than six months.
    • Smoking in the home should be avoided; smoke can worsen a child’s cough.
    • Keep the child’s head elevated. A child may be propped up in bed with an extra pillow. Pillows should not be used with infants younger than 12 months of age.
    • Other therapies, such as antibiotics, cough medicines, decongestants, and sedatives, are not recommended for children with croup. Antibiotics do not treat viruses, which cause most cases of croup.
    • Parents should not leave child unattended for long time especially during night so that they will be immediately available if the child begins to have difficulty breathing.

Unfortunately, there is no way to prevent croup. There are no vaccines against most of the viruses that can cause croup.

Simple hygiene measures can help to prevent infection with the viruses that can lead to croup. These measures include:

  • Frequent hand washing with soap and water.
  • Use of alcohol-based hand rubs.
  • Avoid close contact with other adults and children with upper respiratory infection when possible. This may be difficult, especially when in public, but parents can try to limit direct contact. In addition, infants or children who are sick should not be sent to day care or school as this can potentially cause others to become ill.
  • Yearly vaccination for the influenza virus is recommended for individuals older than six months, who are having repeated respiratory illnesses.

Whenever in doubt its always better to consult your child specialist/ Pediatrician.

stay healthy

Regards

Dr Rahul Varma